Issue link: https://optometricmanagementsupplements.epubxp.com/i/531600
JUNE 2015 • 11 13. Korobelnik JF, Do DV, Schmidt-Erfurth U, et al. Intravitreal afibercept for diabetic macular edema. Ophthalmology. 2014;121:2247-2254. 14. FDA approves Lucentis to treat diabetic retinopa- thy in patients with diabetic macular edema [press release]. Silver Spring, MD: U.S. Food and Drug Administration; February 6, 2015. http://www.fda. gov/NewsEvents/Newsroom/PressAnnounce- ments/ucm433392.htm. Accessed April 7, 2015. 15. Ip MS, Domalpally A, Sun JK, Ehrlich JS. Long- term effects of therapy with ranibizumab on diabetic retinopathy severity and baseline risk factors for worsening retinopathy. Ophthalmology. 2015;122:367-374. 16. Avery RL, Castellarin AA, Steinle NC, et al. Systemic pharmacokinetics following intravit- real injections of ranibizumab, bevacizumab or afibercept in patients with neovascular AMD. Br J Ophthalmol. 2014;98:1636-1641. 17. Wells JA, Glassman AR, Ayala AR, et al; Diabetic Retinopathy Clinical Research Network. Afibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med. 2015;372:1193-1203. 18. Chakravarthy U, Harding SP, Rogers CA, et al; IVAN Study Investigators. Alternative treatments to inhibit VEGF in age-related choroidal neovascu- larisation: 2-year fndings of the IVAN randomised controlled trial. Lancet. 2013;382:1258-1267. 19. Goldberg RA, Flynn HW Jr, Miller D, Gonzalez S, Isom RF. Streptococcus endophthalmitis out- break after intravitreal injection of bevacizumab: one-year outcomes and investigative results. Ophthalmology. 2013;120:1448-1453. 20. Ciulla TA, Walker JD, Fong DS, Criswell MH. Corticosteroids in posterior segment disease: an update on new delivery systems and new indica- tions. Curr Opin Ophthalmol. 2004;15:211-220. 21. Gillies MC, Lim LL, Campain A, et al. A random- ized clinical trial of intravitreal bevacizumab versus intravitreal dexamethasone for diabetic macular edema: the BEVORDEX study. Ophthalmology. 2014;121:2473-2481. 22. Boyer DS, Yoon YH, Belfort R Jr, et al; Ozurdex MEAD Study Group. Three-year, randomized, sham-controlled trial of dexamethasone intra- vitreal implant in patients with diabetic macular edema. Ophthalmology. 2014;121:1904-1914. 23. Cunha-Vaz J, Ashton P, Iezzi R, et al; FAME Study Group. Sustained delivery fuocinolone acetonide vitreous implants: long-term beneft in patients with chronic diabetic macular edema. Ophthal- mology. 2014;121:1892-1903. DR. PIZZIMENTI: Dr. Albini, what is the optimal treat- ment strategy for this patient? DR. ALBINI: I would likely obtain a fuorescein angio- gram to look for leaking focal microaneurysms ame- nable to laser treatment. I would then initiate monthly anti-VEGF injections in both eyes. This will not only treat the DME, but also the retinopathy. DR. PIZZIMENTI: What are the implications of DRCR.net Protocol T in this case ? DR. ALBINI: In a patient such as this, with visual acuities of 20/40 or better, Protocol T concludes that any of the three anti-VEGF agents — afibercept, ranibi- zumab or bevacizumab — work equally well. I would let the patient choose which agent he preferred, likely based on pricing considerations . Case and images provided by Joseph Pizzimenti, OD, and Sherrol Reynolds, OD. Figure 3. OCT shows diffuse macular edema with center involvement in both eyes. continued from page 9 DME Please take the post test and evaluation online by going to OptometricManagementDMECE.com